Does a palliative care clinic have a role in improving end-of-life care? Results of a pilot program

Does a palliative care clinic have a role in improving end-of-life care? Results of a pilot program

Casarett DJ; Hirschman KB; Coffey JF; Pierre L

Journal Of Palliative Medicine

2002

Female; Humans; Male; United States; Adult; Aged; Middle Aged; Pilot Projects; Program Development; Program Evaluation; Survival Analysis; Hospitals; Proportional Hazards Models; 80 and over; Outpatient Clinics; Hospice Care/methods/trends; Hospital/organization & administration; Palliative Care/methods/organization & administration/trends; Veterans/organization & administration

OBJECTIVE: To assess the efficacy of a palliative care clinic (PCC), which provided some of the interdisciplinary services and expertise of an inpatient consult service to outpatients, in traditional clinic sessions. DESIGN: Chart review. SETTING: A large urban Veterans Administration Medical Center. PATIENTS: One hundred patients referred to clinic. INTERVENTIONS: Palliative care clinic. OUTCOME MEASURES: Patients' reported needs, Global Distress Index (GDI) subscale, hospice eligibility, and time to death. RESULTS: The most common diagnosis was cancer (n = 85). Most patients (n = 89) had at least one need for services that the team provided (median, 2; range, 0-4), the most common of which was a desire for information about prognosis (n = 84). In a Cox proportional hazards model, predictors of enrollment in hospice included white ethnicity (hazard ratio, 3.42; p < 0.001), a need for help around the home (hazard ratio, 3.26; p = 0.002), and insufficient money left at the end of the month (hazard ratio, 2.39; p = 0.014). CONCLUSIONS: The experience of the PCC described here offers a unique approach to improving end-of-life care for those outpatients who may not be well served by existing structures of care such as palliative care consult services and who have not yet enrolled in hospice.

2002

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